Health Care Debate: Sanders vs. Graham, Cassidy, and Klobuchar

By Lambert Strether of Corrente.

Here’s a quick review of Monday’s health care debate on CNN, which was so one-sided as to be dull. (During the debate, Yglesias tweeted: “The problem with Lindsey Graham debating health policy on national television is he doesn’t know anything about it.”) One-sided in favor of Sanders, I mean. I put Sanders on one side, and Graham, Cassidy, and Klobuchar on the other, not merely because he is an independent, and they are not, but because they put markets first, albeit in different ways, and Sanders puts people first (and mostly working class people, since there are more of them, and all would benefit from a universal program like Medicare for All.

Here’s the transcript. From the many rich exchanges, I’ll select and briefly annotate three topic areas, each of which illustrate wily veteran Sanders and his debating skills (in one case, simply evading an important issue).

1) Democratic Splits on Medicare for All (or, watch Sanders steal the liberal Democrats’ clothes)

2) Everybody Hates the Insurance Companies (or, watch Sanders turn an admission to his own advantage)

3) “States’ Rights” Is Lousy Health Care Policy (or, watch Sanders let Graham hang himself)

(1) Democratic Splits on Medicare for All

Here’s Sanders on the relation between the (now-defeated) Graham-Cassidy bill, ObamaCare (the ACA), and Medicare for All (S1804). He makes the same argument three times in different ways, and I’m quoting at length so you can see how he does it (and maybe deploy your own talking points).

SANDERS: We are looking at legislation supported by the majority[1] party which is opposed by every major health care organization in the country…. So our job right now short term is to defeat this proposal, and with a little bit of luck, that’s what we’ll do.

But that is not good enough. Our job now is to come together to craft serious short-term solutions that addresses the real problems that exist, high deductibles, high copayments, high premiums, high cost of prescription drugs. But longer term[2], we have got to come together and finally conclude that as a nation we cannot be the only nation, major nation on Earth not to see health care as a right.

Version two:

SANDERS: [O]ur job now is to defeat this disastrous proposal, get back to the drawing board, see if we can work together for some short-term fixes. Long term, in my view — I speak only for myself — this country has got to join the rest of the industrialized world, guarantee health care as a right of all people.[3]

Version three:


I don’t think Medicare for all is an extreme idea. Every other major country on Earth guarantees health care to all people as a right. We end up spending, because of the dysfunctional and complicated system that we have right now designed to make insurance company profits, we spend twice as much per capita as any other country on Earth…

So to do it, every other major country on Earth is doing it. I live 50 miles away from Canada. I don’t think that that is a radical idea.[4]

But clearly, Medicare for all is not going to pass so long as my Republican colleagues control the Senate and the House. So what do we do?[5] How do we work together?

Well, here’s one idea. One idea is to take on the pharmaceutical industry. You’ll remember that Trump talked a whole lot during his campaign about how the pharmaceutical industry was ripping us off. He was right.[6] Let us work together. Let us have Medicare negotiate prescription drug prices. Let us have re-importation so that pharmacists and distributors can purchase lower cost medicine abroad.[7]

Now contrast Klobuchar’s incremental, Clintonian approach (Klobuchar, note well, is not a sponsor of S1804).

KLOBUCHAR: And I think every mom and dad should be able to take care of their kids that way and be able to have insurance. I believe politics is about making people’s lives better. But this bill, it doesn’t do that. It kicks millions of people off insurance. It raises the premiums. It basically passes the buck to the states, but doesn’t give them the bucks to cover people. So that’s why[8] I think we need to work together on the plans that are already underway to fix the Affordable Care Act and put the politics aside and focus on people first.


KLOBUCHAR: What could we do immediately?[9] And that is the work that’s being led by Republican Senator Alexander, Democratic Senator Patty Murray to come together to say, look what they did just now in Minnesota. Republican legislature, my state, Democratic governor came together[10] and said let’s do something called reinsurance, which makes it so the most expensive person in a pool who’s had some major catastrophic health event, they get siphoned off and paid for by the government so that everyone else’s rates don’t go up. This is the kind of proposal they’re working on for the nation, along with other ways to help with co-pays and to allow states[11] to design some of their own insurance without — without — making the drastic cuts that we see in the bill that my colleagues have proposed.


KLOBUCHAR: [Y]ou can have things available to you like treatment, right, but if it’s too expensive, is it really available to you? And if you see a Ferrari in a car lot, well, it’s available to you, but you can’t really buy it. And that is the problem if the prices skyrocket.

So it’s doing something immediately to stabilize these prices, but then in the long term making sure we can make health care more affordable. Bernie has one idea; I have some others. And we can talk about them later.[12]

NOTES to Section (1)

[1] Wretched framing. You’re not on the Senate floor now, Bernie!

[2] For Sanders, the strategic (“longer term”) goal is health care as a right (operationalized as Medicare for All. Short-term solutions function at the tactical level, in service of the long-term goal. Sanders, in other words, insists — and given the generally positive reaction to his performance in this debate, and on the post-election trail, proves — that it’s possible to walk and chew gum at the same time. The Democrat establishment, by contrasts, insists that it cannot. The chewing gum part (#SaveTheACA) comes before the walking part (#MedicareForAll). But what if they never stop chewing their gum?

[3] Same tune with different lyrics: “industrialized world” vs. “major nations”, “see” vs. “guarantee”, “right” vs. “right of all people.” (Personally, I’m suspicious of rights-based framing, simply because we have a Bill of Rights, which suggests it would take a Constitutional Amendment to pass Medicare for All. Surely the universal concrete material benefit is enough?

[4] Same tune, different lyrics, with an overture making the case that it’s our system that’s the extreme, the outlier (though I think it would have made sense to mention that Canada not only has half the costs, it has equal or better health outcomes; superior longevity, for example, where in some areas of the United States longevity is actually decreasing.

[5] Sanders again brings strategic thinking forward: long term vs. short term. This is an effective debating tactic, since Sanders frame any incremental fix as a tactical maneuver within his larger strategy. (Clinton’s vicious memoir characterizies this as the “six minute abs” approach. Clearly, it annoyed her, probably because the tactic takes her incremental proposals and reframes them as mere steps toward a larger goal she does not accept. In other words, Sanders is “stealing her clothes,” as the old political saying goes; taking his opponents talking points and adapting them to his own purposes, leaving them defenseless. (This is the “gone swimming, clothes stolen” trope (although the site doesn’t list a political usage, oddly.)

[6] Ouch!

[7] Medicare negotiating drug prices is, of course, a proof of concept for cost savings under Medicare for All. On drug reimportation, Graham actually says: “[L]et me think about that. John McCain says it’s a good idea.”

[8] “That’s why” (we need to make incremental changes to ObamaCare). No, it isn’t1 Klobuchar doesn’t give a reason! There is no why (although she does get in a subtle dig against Sanders, implying that he’s not putting people first.

[9] Unlike Sanders, Klobuchar never goes beyond “immediately” to anything other than the health care system we have, incrementally improved. In other words, there really is a split within the Democrat Party, as shown clearly by the Senators who signed up for S1804, and those who (like Klobuchar) did not. Since Medicare for All is popular with the Democrat base and independents, it’s a wedge issue, and what Sanders needs to do is make it as easy as possible for Senators to come over from the dark side. (Hence complexities in S1804 like a lengthy phase-in, a public option, starting out by lowering eligibility, insuring children immediately, and so on.)

[10] I don’t make a fetish of bipartisanship. The AUMF was bipartisan. The USA PATRIOT Act was bipartisan. The Grand Bargain is bipartisan by definition.

[11] Klobuchar is closer to Graham and Cassidy’s “states’ rights” position than she is to Sanders (and the co-sponsors of S1804).

[12] “We can talk about them later.” This is why we can’t have nice things.

(2) Everybody Hates the Insurance Companies

I’ve helpfully underlined Graham’s admission immediately below. Now watch what Sanders does with it>\:

GRAHAM: The biggest winner under Obamacare is insurance companies, not patients. And I intend to change that.

SANDERS: Whoa, whoa, whoa.


I like that.

GRAHAM: All right, good….

SANDERS: See, Lindsey, there it is. You actually said something that was right. I knew it would happen.[14]

GRAHAM: I was due, Bernie.

SANDERS: What he pointed out — I’m extrapolating a little bit, Lindsey — but what he pointed out is, why do we have — why do we end up spending twice as much per capita on health care as any other country? And Lindsey is right.

This system is designed to make billions of dollars in profits for the insurance industry. We spend 12 percent to 18 percent to administer the incredibly complex hundreds of plans that we currently have[15]. And with these guys, if they got their way, there would even be more plans, more bureaucracy, more complexity, more money going to the insurance companies.

Medicare, the administration of Medicare costs approximately 2 percent. So if we are serious about moving to a cost-effective universal health care, yeah, we do have to take on the insurance companies. They do not play a role in providing health care. Our money should be going to doctors, to nurses, to hospitals, not to the insurance industry or, in fact, the drug industry, which is charging us by far the highest prices in the world.

BASH: Senator Graham, you were shaking your head. Is the bromance[16] over already?

GRAHAM: Oh, no, no. No, Bernie is the most honest person in the Senate because he believes in government running health care from cradle to grave[17]. All I would say is that Medicare is coming unraveled. By 2038, the trust fund is going to run out of money[18].

NOTES to Section (2)

[13] The rumpled and uncharismatic Sanders does very well with crowds.

[14] Impressive improvisation from Sanders.

[15] Sanders, unlike the others, uses data well. Some would, however, choose to say that profit as such is the problem, and not only administrative costs. But Sanders doesn’t go there.

[16] Personal note: I loathe that portmanteau word.

[17] A very dishonest description of single payer, which is just that: Single payer. Globally, single payer is the centrist position, with Britain’s cost- and medically effective National Health Service, where doctors are government employees, being much more like the Graham’s bugaboo.

[18] This is the important issue Sanders evades, and which Graham continually harps on. Funding. Of course, Canada and all the other major industrialized countries in the world manage to fund their universal programs, so it would seem strange indeed that the world’s richest country can’t fund it’s own, but let that pass. Since the Federal government is the currency issuer, it can no more “run out of money” than a bowling alley can run out of points, but since Sanders has not embraced MMT, he can’t say that. And since Sanders has not — I think wisely, from a tactical perspective — settled on a funding mechanism for S1804, preferring to issue a white paper with several options, he can’t say how he’ll “pay for” his program either (although his data strongly hints that when you consider the country as a whole system, of which government spending is one part, his program pays for itself).

(3) “States’ Rights” Is Lousy Health Care Policy

I suppose it would be possible to call Graham’s thinking Federalist, but I’d rather go on the offensive and label it “states’ rights.” Structurally, they’e the same. Sanders lets Graham hang himself on this one:

[GRAHAM:] So let’s talk about our idea to fix it. Our idea is to take basically the same amount of money we would spend on Obamacare, give it to a bureaucrat you’ll never meet or know or could care less about you, and block grant it back to the states in a fashion to give it to people closer[19] to where your daughter lives, and you can have a say about what they do for your family and there are guardrails. You can’t build football stadiums with it. You can’t build roads and bridges. You’ve got to spend it on health care.

This worked in welfare reform in 1996[20] when 74 United States senators said let’s take welfare and block grant it back to the states and see if they can do a better job. Since 1996, we haven’t had one penny increase because they did a better job. …

The one thing I do know, that Obamacare is going to fail and Bernie’s solution is more government, not less. I don’t see how in the world that Medicare is going to survive[21] for the next generation unless we reform it now. …

BASH: Senator Sanders, would you like to respond? Senator Sanders, he invoked Senator Sanders. Senator Sanders, would you like to respond, since Senator Graham mentioned your name?

SANDERS: I will just — first of all, when you ask the American people about whether or not they like Obamacare compared to your plan, overwhelmingly the American people like the Affordable Care Act.[22]

GRAHAM: How many people know who Graham-Cassidy are?

SANDERS: Second of all, one second. One second. Second of all, it is easy to beat up on big, bad federal government. Guys, do you know what the most popular health insurance program in America is? It’s not the private insurance industry. It is…

GRAHAM: Medicare.

SANDERS: Medicare, yeah!


GRAHAM: Which is falling apart.

SANDERS: Senator Cassidy and I are both on the Veterans Committee. Go out and talk to veterans. And what the polls show is that veterans are very, very positive toward the V.A. Does it have problems? God knows it does. But veterans feel very good about it. It, in fact, is the second most popular health care program in the country. OK?

So the point is it’s easy to say Obamacare isn’t perfect. Everybody knows that. But the truth is that what people in this country see is a health insurance system designed to make insurance companies and drug companies huge profits. They want a cost-effective system that, in fact, deals with the needs of our people and not just the CEOs of large corporations.

And that is why I personally believe that if Medicare is working well for seniors right now, we can make it work for every man, woman, and child in this country through a Medicare for all program.


NOTES to Section (3)

[19] The states being “closer” to the people is a standard “states’ rights” trope. Note that above, Klobuchar agrees with it. Of course, 50 payers have a lot less clout with vendors than a single payer does, so that closeness has a very real price.

[20] Ouch. Thank you, Bill Clinton!

[21] Graham again hammers on funding, and Sanders evades.

[22] Sanders is not directly responsive; he gives no reason why Graham is wrong in principle; he might at least ask Graham if the block grants will be counter-cyclical, so states don’t have to cut health care funding in hard times. Instead, Sanders points to programs that are Federal, and not state, that are — the standard adjective is “wildly” — popular: Medicare, and the Veterans Care.

[23] And the wrap-up. Throughout, Sanders is hammering on what works: Canada (single payer); and Medicare (single payer for 65 and over). The Federalist approach of Graham-Cassidy does not have that virtue; it’s not tested. The incrementalist (and Federalist-lite) proposals from Klobuchar might work, but they clearly don’t deliver universal concrete material benefits, and it’s not clear how much they really fix.


I find it fascinating that Graham-Cassidy actually propose a principled program, even if they happen to be the wrong principles. States may be different in their health care needs — think Flint and lead — but that doesn’t mean they need to be different in their standards of care, or in their back office (“single payer“) functions. Klobuchar, by contrast, seems unable to explain why her incremental approach is correct; she simply takes “never, ever” single payer as a given, and makes Graham-Cassidy’s Federalism bipartisan. Sanders, by contrast, is effective on a number of levels: Facts and figures, stealing his opponents clothes, evading attacks when overt defense wouldn’t further his case, and making an overarching strategy visible. Sanders has the strengths that many years of advocay can bring. Readers, you know my priors, but wow.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


    1. Pavel

      Lambert — you want “bromance”? McCain and Graham are the most nauseating example. It’s rather like Yogi Bear and Boo Boo bear, but the latter two each have more intelligence than M + G combined. And they started fewer wars.

  1. Watt4Bob

    A very important thing to keep in mind is the fact that there is a clear history of states using block grants, or should I say misusing block grants for purposes other than intended.

    It’s well known that state and local governments are facing budget difficulties, and block grant money is being used to plug the holes in many states budgets, and those holes are not always perfectly, or even legally aligned with the regulations governing the use of the grants, let alone their stated purpose.

    And over time, the problems grow larger, but the grants do not.

    From the Los Angeles Times;

    The CBPP study observes that the real problem with block grants is their inflexibility. When a program is converted from federal funding to block grants, the initial grant is typically pegged to the most recent spending on the program, but there’s rarely any mechanism to revisit the funding as conditions change or in light of population growth.

    Another issue is the nature of the vaunted ‘flexibility’ block grants enable;

    Also from the Los Angeles Times;

    States can set income ceilings for Medicaid eligibility themselves, within a wide range. In Alabama, which has not expanded Medicaid, parents are excluded if they earn more than 13% of the federal poverty line, or about $1,500 a year, and childless adults are excluded entirely; in California and other states that accepted the expansion, adults are eligible with earnings of up to $15,800.

    Block grants are part and parcel with our country’s dedication to neo-liberal economics and its fixation on austerity.

    Austerity for thee, and tax-cuts for me.

    1. Bobby Gladd

      “block grant money is being used to plug the holes in many states budgets, and those holes are not always perfectly, or even legally aligned with the regulations governing the use of the grants, let alone their stated purpose.”

      Yep. Given the broad discretion typically contained in legislation — “as the Secretary shall determine” — HHS Secretary Tom Price will run rampant in this regard.

  2. Ep3

    “ Since 1996, we haven’t had one penny increase because they did a better job. …”. Who hasn’t had one penny increase? The federal govt? Because from my understanding of block grants, doesn’t the govt say to the state “here this is all you get good luck”. So there would never be a cost increase. And then when the state runs out of money, because of 2008, the state just cuts back on its benefits, so people starve, or the state goes into bankruptcy to feed its people.

    1. Roger Smith

      Exactly! I read that and was like, “wait a second…”. My understanding is that the block grants were given to avoid responsibility and having to increase cash flow into programs. The amount request may not have gone up but I’d bet a quick research expedition will show that the quality of welfare care has plummeted since Clinton kicked the “welfare queens” to the… other curb(?).

      I can appreciate the “States’ needs/rights defense” but they also need to argue to me that the states are all capable of handling the burden and providing adequate healthcare administration, which is incredibly important and something I am thinking they are not all qualified to do. Healthcare makes way more sense at the federal level, everyone needs it.

  3. cm

    KLOBUCHAR: What could we do immediately?[9] And that is the work that’s being led by Republican Senator Alexander, Democratic Senator Patty Murray to come together to say, look what they did just now in Minnesota. Republican legislature, my state, Democratic governor came together[10] and said let’s do something called reinsurance, which makes it so the most expensive person in a pool who’s had some major catastrophic health event, they get siphoned off and paid for by the government so that everyone else’s rates don’t go up.

    Let us never forget that Sen. Murray (D-WA) voted against allowing Canadian drugs to be purchased by Americans, because of the dangers inherent from those untrustworthy Canadians and their incompetence at ensuring drugs are safe. When I asked her office for examples of deaths in Canada due to shoddy drugs they were surprisingly unable to answer my question.

    1. False Solace

      Fie on Klobuchar, my senator. She compares the health care you need to save your life to not being able to afford a Ferrari! If I were her primary opponent I’d pillory her for that.

      Klobuchar needs to get on board Sanders’ bill like her colleague Franken did. Simply pathetic.

      Thanks much for the article Lambert.

      1. Doro Reeves

        I don’t think Klobuchar’s point was to put healthcare in the same luxury-item category as a Ferrari. Her basic premise is that anything with a price tag that puts it beyond reach is not accessible, nor does it anyone any good.

  4. Roger Smith

    I would have liked to have heard Sanders (or anyone) level the basic question, “What are insurance companies actually doing?/What is the need that they facilitate a solution for?” He seems to get close in section 2. Insurance companies do basic administrative work while tapping the jugular vein of money flow into the healthcare system. There is absolutely no defensible reason for their gross and negligent profiteering. These debate answers seem to ignore a more basic premise such as this (though they do include the other obvious, “everyone else is doing it… so wtf?”). You can argue for or against universal care, but fundamentally this current arrangement makes absolutely no sense. I would like to hear someone defend for profit insurance systems in the mix as well.

    1. Bobby Gladd

      No amount of calling for-profit, dubious value-add 3rd-party intermediated pre-payment plans “insurance” will make them so. Only part of these contracts are “insurance” in the catastrophic risk-hedging sense. The bulk is simply administrative paper churn. But, “every misspent dollar in the health care system is part of someone’s paycheck.” — Brent James, MD, M.Stat

      1. Jim Thomson

        True that the money is someone’s paycheck. But, they could be paid for doing something more useful and productive.
        Much “work” is unproductive, such as the “health” insurance companies; churning derivative contracts, etc, must stop here…..

    2. JacobiteInTraining

      I worked IT for a major health insurance company, (one of ‘The Blues’) in the last 5 years, for a total of maybe 7 years service with them, and from this perspective I saw some positives: (noting, of course, that i was a computer guy and often only had a generalized/simplistic view of what the apps i worked with actually did)

      – The Blues operate in a somewhat coordinated fashion with processes, procedures, software, and similar things. To the extent that they agree on same…it would appear there is at least some coordination of ‘overhead’ in the form of planned compatibility and exchanges of data (i.e., claims) It was not, as far as i could see, a complete free-for-all in which every insurance company had a completely customized system that could not be made to talk with any other.

      – There was software implemented that tried to drive prices down: In one case, an app that checked provider billings against standardized ‘expected actual cost’ for same/similar procedures, adjusted by regional differences, and then flagged suspicious costs, additional unexpected costs on procedures providers may have included not normally associated with the patient diagnosis. I personally saw this in action on my own claims when i finally got the paper EOBs – very often the initial high $$ items from the provider were ‘disputed’ and subsequently reduced by that provider.

      – I saw implementation of several apps whose purpose was to analyze the data of historic/recent patient claims, provider diagnoses, and other points in order to identify as-yet undiagnosed health issues proactively for insured members. Yes, this would still be driven by the profit motive (insurer identifies claims that *might* indicate early stages of what could become a way more expensive diabetes diagnosis, for example, and then forwards specific information to member on how to correct such conditions before they happen, mitigate impacts, and/or get less expensive treatment NOW that would prevent more serious or life-threatening issues – and much higher costs – down the line if left unaware/unaddressed/untreated.

      – The front line Customer Service people I dealt with (the worker bees of the organization) were pretty much always caring, interested, intelligent folks. They worked damn hard for their money and (though I know it may seem different on the other end of the phone line) …the ones i worked with *wanted* to help members. They did their best with the info at hand in the computer systems, and when trying to navigate complex, confusing, and often self-contradictory policies on the member’s behalf.

      From a negative perspective:

      – i had a certain amount of contact with the ‘brass’ (upper management, CEOs, CIOs etc) and with almost no exceptions, i found them to be smarmy, clueless, back-stabbing, venal, and uninterested in what ‘the folks on the assembly line’ thought about *anything*. Middle and lower-management (mainly the long time veterans who had worked their way up *in* insurance/or health care of some form) tended to be good and caring. More recent management hires (grabbed from pretty much *any* industry) tended to be brusque, uninterested, and mostly interested in counting beans. (if I hear the phrase ‘METRICS, GET ME METRICS!’ at any time for the rest of life, it will be too soon)

      – We had a metric–ton of IT people: Developers, sysadmins, testers, program managers, contractors, etc., etc., and to keep them all busy & employed we had projects, projects, and more projects. Many went nowhere, some failed horribly, many ‘produced’ fancy things and new shiny objects for the website that….once analyzed…members neither wanted nor ended up using. Often, the most important projects (the ones that had to do with the basic ‘light on doors open’ softare app & its upgrades) ….were softpedaled, delayed, aborted, or otherwise shortchanged by management in order that some sexier project would get the needed resources and ‘succeed’. (and with success…gosh…more shiny objects and pretty pages noone wanted nor used nor cared about…outside of management bonus time)

      Anyway, although I didn’t see this particular health insurance company as Sauron-incarnate, I also didn’t see them as any kind of critical component to national healthcare success. despite my own generally anti(corrupt)government leanings….I have the distinct feeling that very VERY much of what is done in the aggregate in the health insurance industry could be done….passably well….by government, either State or Federal.

      1. Watt4Bob

        Often, the most important projects (the ones that had to do with the basic ‘light on doors open’ softare app & its upgrades) ….were softpedaled, delayed, aborted, or otherwise shortchanged by management in order that some sexier project would get the needed resources and ‘succeed’. (and with success…gosh…more shiny objects and pretty pages noone wanted nor used nor cared about…outside of management bonus time)

        Sounds like you just described precisely, the recent problem with one of our credit rating agencies?

        Isn’t it bothersome to understand totally, the causes of problems that our best and brightest just can’t seem to grasp?

        1. JacobiteInTraining

          “…Isn’t it bothersome to understand totally, the causes of problems that our best and brightest just can’t seem to grasp?…”

          I hear ya! I think my problem is that I’m smart enough to know that I *don’t remotely* know the totality of the causes and impacts and implications of the problems faced. To slightly alter your premise I think I would say that the worst – of the best and brightest – are so 100% certain they *do* know the answer, that they no longer ask the questions. :(

    3. Homina

      I think that could also apply to all insurance–fire, auto, house, etc. The insurance racket may be the most obviously positive nationalization industry ever. Or if not nationalization, perhaps the only monopoly allowed, if just one company is available and is reasonably cheap; and overall is cheaper than what a consortium of the other cartels (many of which have been proven to price-fix). And if forced to cover all Americans/cars/etc, it should be.

      The only downsides I see at all (keep in mind I have almost zero clue about economics so might be completely wrong) from nationalizing insurance industries are 1) job-loss, but that’s already a problem. And there should be a UBI anyway that would make this moot, and 2) if not well-regulated (if private monopoly) or a target of ridiculous bills/budget crap (if public). Those downsides aren’t actually problems in a well-developed society that would instead easily deal with both. I mean assuming the government of such a society is moral. That appears to be the major problem.

      Auto insurance may be the most akin to Obamacare–legally forced to buy it, and for the dregs from various vulture vendors who use actuaries to assess for max profit, not for dollars in-dollars out parity.

      Had two accidents in the past ten years? Another $50 a month. Smoked for five years decades ago? Another $50 a month. Obviously, a good portion of that $50 goes to profit. Multiply by hundreds of millions of people.

  5. Knifecatcher

    Great summary, Lambert. I was also struck by the obvious “Clinton-lite” mindset of Sen. Klobuchar. Her solutions for these incredibly complex problems all seemed to involve creating more complexity.

    One thing I was disappointed about was that nobody called out Graham for that ghoulish “Planned Parenthood body parts” comment. Three people were murdered in Colorado Springs by a nut-job who was motivated by that bogus video, Lindsey. You’re really going to go there?

  6. relstprof

    Wasn’t Stephanie Kelton an economic advisor to Sanders? I’m mystified why he doesn’t have an MMT soundbyte response ready to go. Is is because he doesn’t buy MMT? Or no one has come up with an easy way to sell it to audiences?

    1. FCO

      I’m thinking Sanders has a chip on his shoulders against the rich and uses the “taxes-pay-for” to get at them. Democrats are allegedly smart and logical. If Sanders uses the MMT framework, his base will surely understand it.

      1. Tom_Doak

        I’m thinking Sanders believes that “tax the rich” sells better to middle-aged non-rich people [the majority of voters] than MMT, which will be derided by conservatives as “magical thinking” and cause middle-aged non-rich people to worry that the Inflation Boogeyman will destroy their modest hope of a comfortable retirement.

        If MMT works then you don’t really have to use it for justification of your policy … you can allow the Senate to continue debating the budget as if they were going to do anything close to actually sticking to a budget.

        1. Darn

          Yep. MMT if you believe in it slays the deficit bogeyman only to raise the spectre of the hyperinflation bogeyman. Might as well just publicly defend conventional deficit spending to begin with.

        2. FCO

          I give us middle-aged non-rich voters the benefit of the doubt that we have enough sense to understand MMT’s views on taxes and the “Inflation Boogeyman”. All is needed is a bit of validation from Sanders ( and other people of his stature).
          Playing on the “tax the rich” mantra just adds fuel to a class warfare that needs to be stopped.
          At this point, selling an idea that is based on propaganda and old mentality instead of selling an idea based on the right framework, IMHO, is futile and at worse, regressive.

    2. paulmeli

      Is is because he doesn’t buy MMT? Or no one has come up with an easy way to sell it to audiences?

      They (MMT academics) leave that ideological tack alone, as it isn’t really part of monetary theory and implicitly supports the notion that taxes fund spending. They prefer not to talk about it.

      The reason we should want to tax the rich (till it hurts) is to reduce their power and overwhelming choke hold on policy. Not many want to go there, even though we taxed the rich at 90% for 30-odd years after the depression and it worked well.

      Been downhill ever since. Reducing taxes on the rich started with JFK.

  7. ChrisPacific

    Is the Bill of Rights supposed to be exhaustive? In other words, is it possible for human rights to exist that aren’t explicitly numbered in the Bill of Rights, but are nevertheless informally recognized as such?

    I appreciate your point on the downsides of asserting it as a right. The thing I like about it is that it is self-evidently true. A defining quality of a civilized society should be that it takes care of its sick, injured and infirm.

    Agreed on bipartisanship – Wall St immunity from prosecution and graded scales of law enforcement for rich and poor are both bipartisan agreements as well (even if implicit) and I’d be happy to see the last of both. I am however a fan of people deciding issues on their merits rather than just basing their position on party ideology or personal alliances. (Graham’s “I need to ask McCain what my opinion is on that topic” was pretty funny).

    On the cost point, I appreciate that avoiding this question may be part of Sanders’ strategy, but I think there is a strong argument to be made here as well. The current US healthcare system is enormously costly. Medicare is (relatively speaking) cheap. Medicare for all, or any relatively sane system, would collectively represent a massive cost saving over the current monstrosity. If that saving somehow fails to be passed on to citizens and/or government, then that’s the government system being obstructive and not a flaw in the proposed healthcare plan itself. (i.e., this is why we can’t have nice things). At which point it becomes reasonable to ask: why is the government system preventing us from having a policy that would clearly deliver better results for everyone for much less money, and what needs to be done to fix it? I hope that Bernie is keeping this one up his sleeve in case there is ever a concerted attack on the cost angle.

    1. Elizabeth Burton

      The Preamble to the U. S. Constitution charges the federal government to “establish justice…[and] promote the general welfare.” Can anyone but an ideologically blinded idiot argue that ensuring “We the People” have access to the care we need to be healthy doesn’t constitute “the general welfare”?

      1. PhilM

        Honestly, I don’t see why the Constitution should pertain to this, when it doesn’t have to do with anything else the Federal government does.

    2. Tim

      The Bill of Rights enumerates natural rights. I do not think anyone in their right mind would consider health care a natural right, but a civil one, which is perfectly reasonable.

  8. Samuel Conner

    Funny thing how people (from both major parties) never seem to fret about how badly underfunded the Foreign Wars Trust Fund is, and never seem to believe that this chronically bankrupt condition will interfere with the further pursuit of foreign wars in the perceived national interest.

    It’s a head-scratcher.

    But in view of their evident tranquility about this, I’m not going to worry about the finances of the Medicare Trust Fund either.

    1. political economist

      Yes, this is a good point. And, since these wars only benefit the super-rich, they owe many tens of trillions to the US government to cover the accumulated debt plus interest for all those missed payments into the trust fund.

  9. dbk

    These posts are much appreciated, really helpful and informative.

    I have always wondered why people in favor of single-payer / Medicare for All don’t use arguments of inequity to debate those touting “states’ rights”. Surely given the much-vaunted mobility of Americans, in a future dominated by block grants, rich states, poor states, blue states and red states there will be very large differences in the amount/quality of healthcare provided across state lines.

    This seems to me a core argument against federalism in health care – unless, of course, someone is willing to argue that some states’ citizens are more equal than others.

    I’d be interested in hearing more about what Sanders and his 16 co-sponsors are suggesting specifically–beyond controlling pharmaceutical prices, possibly by trying the re-importation idea again–to stabilize the ACA short-term. Because that really needs to happen, like last week.

    CSRs subsidies need to have guaranteed month-over-month payments – the uncertainty has been a major destabilizer in the private market. What about bare-shelf counties? The right to be covered by Medicaid, perhaps, capped at ~9% of one’s annual income? It would perhaps be better to start enrolling people in such counties in Medicare, but I’m not sure how easy that would be under state insurance exchanges.

    Klobuchar was pretty underwhelming.

  10. Tom_Doak

    Lambert, your line that “the Federal government can no more run out of money than a bowling alley can run out of points,” is both hilarious and clarifying. I don’t know if you have used that example before but I hope you keep using it !

  11. XXYY

    One argument from the right-wingers that seems to keep getting a pass is that by delegating healthcare money to the states in the form of block grants, people will somehow have more control over it than they do healthcare money administered at the federal level.

    First of all, this is obviously a crock. I don’t know how it is in other states, but in my state the government is extremely opaque, its workings get almost no news coverage, and the caliber of the state politicians seems to be extremely low. Everyone seems to be almost exclusively grubbing for money and positioning themselves for post government work since our state imposes term limits on politicians. So the idea that devolving power to the state government is going to lead to something virtuous seems very questionable.

    Secondly, why are right-wing forces so interested in devolving the authority for healthcare money to the states? I assume it’s because they know that at the level of 50 state governments there is more opportunity for skullduggery and corruption then there is at the federal level. Otherwise, they would be advocating to keep healthcare money at the federal level.

    So I think we need to call out the claim that “states will do things better because they are closer to you”, which is in many ways the central argument for the Graham Cassidy legislation and other similar things. I don’t think there’s any evidence for it whatsoever.

    1. Steven Greenberg

      Graham kept saying that if you don’t like the program as run by Washington, who are you going to complain to. Sanders never mentioned that you complain to Trump, Graham, and Cassidy when they actively sabotage the current ACA. Since Graham and Cassidy both mentioned that Sanders was more honest than they were, he could have claimed that it was a tacit admission that what he was saying had more truth to it than what the other side was saying.

  12. Steven Greenberg

    Bernie let the other side go on and on about the horrible failures of ACA without ever mentioning that the Republicans and Trump in particular are actively sabotaging the program.

    If you think Sanders did such a wonderful job, then you aren’t reading what the Trump trolls are saying about the debate. You would be surprised at what they think of Bernie Sanders.

    From our point of view it might look like Sanders did a great job. However, consider the point of view of the other side. Since the other side assumes that everything that Bernie says is a lie and everything that Trump says is true, then Sanders didn’t convince many people who weren’t already convinced.

    1. Lord Koos

      Vocal Trump supporters online are a minority but they make a lot of noise. And who knows how many of them are bots?

    1. cnchal

      bezzle – verb

      to waste (money)

      I watched the debate and do not recall any criticism of the hospitals. No comments about administrative bloat or coding upgrades by doctors to balloon hospital bills and out of network disasters. At one point I was hoping Bernie would simply say to the smarmy Graham and super smarmy Cassidy “there is always money for the next bombing run in Afghanistan, what the hell is the matter with you”?

      A total lost opportunity to stick a verbal grenade up their butts.

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